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PCR Testing Solution 99% effective at 28 days???
Jan 17, 2005

Dr. Bob,

I have read and understand your statements VERY clearly on PCR testing for screening, but want your opinion on this.

The reason you always state the PCR test is not good for screening is false positives and expense. While I know you wish we were all more frugal and then donated our money to the needy AIDS stricken of Africa (logically), MANY of the people that write into this forum are DESPERATE (at least their mental state is).

The people are either married, in a relationship and/or scared to death. Many probably spend far more than a PCR test costs on a psychologist to help them deal with the situation...OR they are spending it on attorneys since they can't make it 3 months of doing "limbo" until their test results come back.

With this stated, many low risk individuals could take a PCR (granted aware of the false positive risk) at one month, then live a normal following two months with this result. I would still personally suggest the follow-up 3 month ELISA, as I am a total worried well myself.

The level of productivity and savings in their/my life of two months is well worth the $280 I was quoted for the PCR test at a local clinic.

I am 8 days post possible low risk exposure, this is my plan currently....so why not do this?

Knowing I (male) wore a condom with a female sex worker for both oral and vaginal sex...I feel pretty secure in dodging my wife for another 20 days (yes, I know it was REALLY stupid to cheat...killing myself on a different level), getting the PCR and a quick HIV ELISA at a clinic. If both come back negative....I think I am pretty safe to move back to a sex life with my wife. I will make sure to wear condoms everytime until three months, but I think it is realistic.

My knowledge of the above statements comes from extensive reading of your site...so thank you. I hope your comment is coming soon...I am counting the days for both this and my negative results.

I will make another donation to your foundation also, you do great work here.

Thanks, Leave it in Vegas, AGAIN!

Response from Dr. Frascino

Hi Vegas-Guy,

Sorry, I cannot endorse your current plan of action. Here's why. You had "protected" sex. If the latex condom was used properly and did not fail, your risk for HIV transmission would be nearly nonexistent. Agree? So if you take an HIV-RNA PCR, the false-positive rate can vary form 2% to 9% (usually at low titer values of less than 10,000 copies per milliliter). If you test positive, you wouldn't know if your positive test was a false positive or true positive. So then what do you do? See the potential downside??? If you decide to take a DNA PCR test, the results, either way, are not considered sufficiently accurate for diagnosis without confirmation. So again you don't really have the reassurance you desire. Right?

Both of these tests, PCR-RNA and PCR-DNA, are excellent tests when used for the appropriate purposes. Unfortunately routine screening in very low risk situations like yours is definitely not one of them, even if you are "paranoid and acting like a freaked-out freak!"

I stand by my previous statements with regard to PCR for routine screening. PCR testing is expensive, time consuming, not available in many laboratories around the world and not recommended for routine HIV screening. Sorry Vegas-Guy. My advice is to confront your real problem your guilt and worry. This is best done by telling your wife the truth and then getting an ELISA test at three months for a definitive result.

Good luck!

Dr. Bob



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